A revered contemplative practice for centuries, meditation has recently inspired research into its therapeutic value for everything from anxiety disorders to heart attack prevention. A painful, progressive autoimmune disease, rheumatoid arthritis (RA) is associated with a high risk of depression--double the risk of the healthy population, by conservative estimates--and various forms of psychological distress. Increasingly, RA patients are turning to alternative therapies like meditation to ease the toll of their disease.

Mindfulness-Based Stress Reduction (MBSR) is a meditation training program developed by Dr. Kabat-Zinn and colleagues at the University of Massachusetts Medical School. MBSR teaches participants to relate differently to thoughts and emotions, and continually focus the mind on the present moment to increase clarity and calmness. The program has been shown to improve psychological symptoms in patients with fibromyalgia, cancer, and multiple sclerosis, among other conditions. Researchers with the University of Maryland School of Medicine set out to assess the effect of this meditation therapy on depressive symptoms, psychological distress, general well-being, and disease activity among RA patients. Featured in the October 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare), their study supports the potential benefits of prescribing a course in MBSR along with the conventional course of physical and pharmacological therapy.

Recruited through community health fairs and ads in Baltimore newspapers, 63 adult RA patients were selected to participate in this novel pilot study. Averaging 54 years in age, participants were mostly female, white, married, college educated, and comfortably middle-class. None had a history of psychiatric illness, alcohol or drug addiction, or other chronic pain disorders. All patients remained under their rheumatologist's care and continued to take their routine medications throughout the study.

Through random assignment, 31 of the participants received intensive MBSR therapy, starting with an 8-week training course followed by a 4-month maintenance program. The remaining 32 participants were designated to a waitlist, agreeing to attend assessment sessions in exchange for free MBSR training after the study's end. At baseline, and again at 2 months and 6 months into the study, both groups of participants underwent psychological and rheumatological examinations. To evaluate depressive symptoms and psychological distress, researchers used the Symptom Checklist-90-Revised, a self-report questionnaire widely recognized for its reliability and validity. Overall well-being was measured by the Psychological Well-Being Scales, comprised of questions designed to gauge positive outlook and approach to coping with difficulties. RA disease status was assessed by the Disease Activity Score in 28 joints (DAS-28).

Researchers compared scores of psychological and physical disease symptoms among MBSR participants with those among controls. Overwhelming, MBSR students embraced the program and kept up their mindfulness practice throughout the followup period. After 2 months, both groups showed improvements in depressive, psychological, and emotional symptoms, with no significant benefits attributed to MBSR. By 6 months, however, gains in the control group had largely disappeared, while MBSR participants maintained or improved further in psychological outcomes. By the culmination of the study, the MBSR group achieved a significant 35 percent reduction in psychological distress. Despite this dramatic improvement, the therapy had no impact on RA disease activity, measured by the DAS-28, which takes into account number of tender or swollen joints, a blood measure of inflammation, and the patient's own report of disease status.

As the researchers acknowledge, the study had limitations, primarily its small sample size and its likely floor effect. On the strength of their backgrounds, participants might have been less vulnerable to psychological distress and depression than RA patients with fewer socioeconomic advantages, not to mention those with a history of mental illness or substance abuse. Yet, these limitations should not overshadow the positive findings and applications. "The study demonstrated that for patients with RA under routine medical supervision, an 8-week MBSR class plus a 4-month maintenance program had beneficial effects, and that it was safe and appealing to participants," notes investigator Elizabeth Pradhan, PhD. "For doctors wishing to offer patients a complement to medical management, mindfulness meditation may offer hope for improving psychological distress and strengthening well-being in patients with RA."

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